UPFRONT

Trouble Ahead

Peter K. Kaiser, MD

Physicians, and retina specialists in particular, woke up the other day to sensational headlines in the New York Times and other papers across the country, stating that a “sliver of doctors get a big share of payouts.”

These stories went on to point out that 17,000 doctors accounted for 7%, or $5.6 billion, of all reimbursement and that of the 100 doctors who receive the largest payments, nearly half are ophthalmologists (the majority are retina specialists). (See article, page 22.)

Now, you (like me) probably went immediately to the conveniently provided link to the flawed “Medicare database” from which they obtained their data, to look up your own numbers and those of your closest friends.

Certainly some interesting outliers exist (none of which I agree with or condone, and that should receive some extra scrutiny from the government) in the list, such as billing for subconjunctival injections with the intravitreal injections, performing ICG exams more frequently than OCT exams in some high-billing practices, and the price of Avastin varying considerably across practices. But what is striking is how misleading this data set is.

Explaining that a large part of the money went directly to pharmaceutical companies ($1 billion or so to Genentech) or that our patients are disproportionately represented by Medicare would have been too much text for these sound bite–driven, attention-grabbing articles.

But it is just as much CMS’ fault for not explaining the data it was releasing or the methodology that it used. For example, looking at my data (I will save you the trouble — $198,292), you would think I should have been fired a long time ago. These are pitiful numbers because the fourth highest-paid doctor in Cleveland was my fellow — when he was a fellow.

Herein lies the problem with this database. The numbers are grossly misleading for many doctors. For example, my numbers and those of the other Cole Eye Institute staff show that we never use anti-VEGF drugs. Interesting … and very incorrect.

It is unfortunate that CMS and the press chose to publish this database in such a manner. Now, we are stuck picking up the pieces and explaining the process to all of our patients (although my patients seem to be very happy with me).

The bigger issue is that these numbers are likely going to be the basis for other Obamacare-mandated measures in the future, in which doctor payments are linked to costs and outcomes. If your “cost” to Medicare is high, then unless your outcomes are off the charts, you can expect a penalty. According to this database, retina is in for a world of hurt.